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K M Krishnamoorthy

Publications and source records attributed to K M Krishnamoorthy.

58 records · Page 4Linked to original sources
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Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance.

BACKGROUND: There is a paucity of data regarding the long-term outcome of patients operated for ventricular septal defect with severe pulmonary arterial hypertension and elevated pulmonary vascular resistance. METHODS AND RESULTS: We evaluated the long-term follow-up results of a selected cohort of patients with nonrestrictive ventricular septal defect and elevated pulmonary vascular resistance (>6 Wood units). Thirty-eight patients, median age 7.5 years (range 6 months-27 years), with nonrestrictive ventricular septal defect with severe pulmonary hypertension were operated between 1985 and 1996 at our institute. Preoperative pulmonary vascular resistance, ratio of pulmonary blood flow to systemic blood flow, and ratio of pulmonary vascular resistance to systemic vascular resistance were 7.63+/-1.8 Wood units, 1.9+/-0.48, and 0.41+/-0.12, respectively. The majority (68.4%) had perimembranous ventricular septal defect. Thirty patients (79%) had a good outcome and were asymptomatic at a mean follow-up of 8.7 years, with significant reduction in pulmonary artery pressures. Eight patients (21%) had a poor outcome, which included 5 immediate postoperative deaths, 1 late death and 2 surviving patients with persistent severe pulmonary arterial hypertension. There was no significant difference regarding hemodynamic parameters at baseline between those who had a good outcome and those who did not. Eleven patients with a preoperative pulmonary blood flow to systemic blood flow ratio of <2:1. who had a good outcome following surgery, underwent repeat catheterization at follow-up. There was a significant reduction in their mean pulmonary vascular resistance (8.03+/-1.4 v. 4.16+/-1.6 Wood units, p=0.001) and pulmonary vascular resistance to systemic vascular resistance ratio (0.41+/-0.12 v. 0.19+/-0.06, p=0.05). CONCLUSIONS: The late results of surgery on this selected group of patients with nonrestrictive ventricular septal defect with high pulmonary vascular resistance are encouraging. Operative correction of the ventricular septal defect should be actively considered in all children presenting with nonrestrictive ventricular septal defect with a significant left-to-right shunt, despite moderately elevated pulmonary vascular resistance. Even among older patients with ventricular septal defect and moderately elevated pulmonary vascular resistance, there is a specific group that does well after operation.

Adolescent↗
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Effect of atrial septal defect created during balloon mitral valvuloplasty on calculation of cardiac output and mitral valve area.

We studied the effect of atrial septal defect (ASD), produced during transseptal puncture, on estimation of cardiac output (CO) and mitral valve area (MVA), after successful balloon mitral valvuloplasty (BMV) using the Inoue balloon in 20 patients. Oximetry run, pressure gradients, thermodilution CO and MVA were measured initially while temporarily occluding the ASD by partially inflating the Inoue balloon catheter. Measurements were repeated after withdrawing the balloon catheter into the right atrium. Post-BMV cardiac output and MVA were similar in both the situations (4.52 +/- 1.37 L/min vs 4.50 +/- 1.19 L/min; 1.89 +/- 0.4 cm2 vs 1.93 +/- 0.38 cm2 respectively, p = ns). Only 2 patients showed a step up at atrial level on oximetry (9% and 16% respectively) but did not have significantly different CO or MVA, both with ASD occluded or otherwise. We conclude that the magnitude of ASD created during BMV by Inoue balloon technique is small and does not significantly affect the estimation of CO or MVA if the septal puncture is done in the fossa ovalis area.

Adolescent↗